Out-of-plane permittivity of confined water.

The dielectric properties of confined water is of fundamental interest and is still controversial. For water confined in channels with height smaller than h=8Å, we found a commensurability effect and an extraordinary decrease in the out-of-plane dielectric constant down to the limit of the dielectric constant of optical water. Spatial resolved polarization density data obtained from molecular dynamics simulations are found to be antisymmetric across the channel and are used as input in a mean-field model for the dielectric constant as a function of the height of the channel for h>15Å. Our results are in excellent agreement with a recent experiment [L. Fumagalli et al., Science 360, 1339 (2018)SCIEAS0036-807510.1126/science.aat4191].

Glaucoma among the Malaysian Community.

BACKGROUND: According to the WHO, glaucoma is the second leading cause of blindness worldwide. About 50% of the world's glaucoma cases come from the Asian population, and in Malaysia itself, the prevalence of glaucoma is increasing. However, glaucoma is still a foreign word to our community despite the high prevalence. Therefore, there is an urgent need to determine the awareness of glaucoma among the community and its associated factors. RESULTS: This study showed that only 25.2% of our respondents were aware of glaucoma and it is associated with ethnicity, religion, education, and household income. Besides, among those who were aware, they fall into the group of poor knowledge of glaucoma. On the other hand, the knowledge of glaucoma was associated with occupation and the awareness of glaucoma by definition. The validated questionnaire was distributed and the data were analyzed by SPSS software using t-test, one-way ANOVA, and chi-square test. CONCLUSION: Awareness and knowledge of glaucoma in this population is low. These findings suggest that there is a need for an efficient information and education strategy to be designed and conducted to increase the awareness and knowledge of glaucoma so that early detection can be made and effective management of individuals with this condition can be delivered.

Management of recurrent heterotopic ossification around total alloplastic temporomandibular joint replacement.

Temporomandibular joint (TMJ) replacement is the gold standard for reconstruction of the ankylosed joint, as it provides the facility for early function and a suitably large gap, both aimed at the prevention of recurrence. The recurrence of heterotopic ossification is traditionally managed by resection, a temporary spacer, and remake of the prosthesis, with placement at a second procedure, which adds to costs and morbidity. Atraumatic removal of the prosthesis, resection of the heterotopic tissue, replacement of the prosthesis into its previous position, and the packing of fat around the articulation represents a technique that both minimizes morbidity and reduces costs. This technique has been utilized in three cases, with early improvement in mobility, function, and pain. It is still too early to determine whether the outcomes obtained will be maintained in the long-term.

Reform follows failure: I. Unregulated private care in Lebanon.

This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres; and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform.

Reform follows failure: II. Pressure for change in the Lebanese health sector.

This paper describes how, against a background of growing financial crisis, pressure for reform is building up in the Lebanese health care system. It describes the various agendas and influences that played a role. The Ministry of Health, backed by some international organizations, has started taking the lead in a reform that addresses both the way care is delivered and the way it is financed. The paper describes the interventions made to prepare reform. The experience in Lebanon shows that this preparation is a process of muddling through, experimentation and alliance building, rather than the marketing of an overall coherent blueprint.

The effects of percutaneous catheter ablation on preexisting permanent pacemakers.

STUDY OBJECTIVE: Determine the effect of percutaneous catheter ablation (CA) on permanent pacemakers. MEASUREMENTS AND RESULTS: Twenty-three patients who underwent CA at The Cleveland Clinic Foundation from September 1983 to January 1990, and had a previously implanted pacemaker were studied. Electrocardiographic data during the CA procedure and clinic data including pacemaker evaluations were analyzed. Fifty-two percent (12/23) of the pacemakers malfunctioned: five developed transient ventricular loss of capture; two undersensing; one oversensing; three could not be interrogated or programmed, and one did not respond to the magnet test. Four patients developed syncopal episodes and two severe dizziness after the procedure. All had their pacemakers replaced. In total, seven were explanted. Destructive analysis by the individual manufacturer identified pacemaker circuitry failure in five. Unipolar pacemakers and anodal ablation procedures had more frequent and severe malfunctions, but the difference was not statistically significant. CONCLUSIONS: Pacemaker malfunction is frequent during CA. It may be prevented by programming the pacemaker, when possible, to the nonfunctioning mode (000 mode). Temporarily disconnecting the pacemaker during ablation requires further evaluation as an alternative approach. Close follow-up can detect pacemaker malfunction and prevent complications.

The use of beep-o-grams in the assessment of automatic implantable cardioverter defibrillator sensing function.

Noninvasive assessment of sensing performance in the automatic implantable cardioverter defibrillator is limited by the absence of telemetry or memory functions. The adaptation of the electrophysiological test mode into a "beep-o-gram" recording, with simultaneous audible tones and a surface electrocardiogram, was used in the confirmation of sensing malfunction. Eleven of 13 recordings in patients with documented or clinically suspected inappropriate defibrillator discharges (group 1) demonstrated evidence of definite oversensing. Nonspecific oversensing or undersensing was present in 77% of 27 randomly selected asymptomatic patients without known sensing malfunction (group 2). The sensitivity and specificity for identifying definite oversensing was 85% and 60%, respectively. The beep-o-gram system is a reliable, noninvasive means of confirming sensing malfunction in the automatic implantable cardioverter defibrillator. Its specificity is limited by the detection of subclinical sensing aberrations, to some degree related to the device's automatic gain control sensing algorithm.